Key result
Timely post-repair PVR may prevent RV failure in ToF, which has ~33% untreated first-year mortality.
Why the study?
When and in whom should pulmonary valve implantation be performed after tetralogy of Fallot repair?
When and in whom should pulmonary valve implantation be performed after tetralogy of Fallot repair?
Timely pulmonary valve replacement in patients with repaired tetralogy of Fallot may prevent irreversible right ventricular failure and arrhythmias.
Residual abnormalities persist after TOF repair; leaves open optimal long-term surveillance strategies.
Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease. If left untreated, it carries a 33% mortality in the first year of life and a 50% mortality in the first 3 years of life. Since the introduction of the first open-heart repair by Lillehei and Varco in 1954, surgical management of TOF has evolved to be the primary repair during infancy in the majority of patients. Surgical management of TOF results in anatomic and functional abnormalities in the majority of patients, such as chronic pulmonary valve regurgitation and right ventricular (RV) dysfunction. Long-standing chronic pulmonary valve regurgitation can result in RV dilatation and failure, increasing tricuspid regurgitation, impaired exercise performance and supraventricular or ventricular arrhythmias. A timely reoperation may prevent these consequences, with a complete RV-function recovery. This article provides insight into the questions of when to perform a pulmonary valve implantation and in whom.
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Piazza et al. (2012) conducted a review in Tetralogy of Fallot (TOF). Pulmonary valve implantation was evaluated. Untreated tetralogy of Fallot carries a 33% mortality in the first year of life, but timely pulmonary valve replacement after repair may prevent right ventricular failure.
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